Efficacy of larger valve sizing with underfilling in balloon-expandable transcatheter aortic valve replacement

Tomohiro Kawaguchi, Toru Miyoshi, Masaomi Hayashi, Kenichi Ishizu, Satoko Ugawa, Kazumasa Nosaka, Akihiro Isotani, Masayuki Doi, Shinichi Shirai, Kenji Ando

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Objectives: To investigate the efficacy and safety of larger valve sizing beyond the commercially recommended annular range in transcatheter aortic valve replacement (TAVR) with balloon-expandable transcatheter heart valve (THVs). Background: The clinical implications of larger balloon-expandable THV implantation with underfilling are poorly evaluated. Methods: This retrospective study included 692 consecutive patients who underwent TAVR with SAPIEN3. A total of 271 patients who underwent SAPIEN 3 implantation were analyzed based on three border zones (Zone 1: 300–345 mm2, 23 vs. 20 mm; Zone 2: 400–430 mm2, 26 vs. 23 mm; Zone 3: 500–546 mm2, 29 vs. 26 mm). The primary endpoint was the effective orifice area (EOA) assessed by echocardiography at 1 year, and secondary endpoints were a 30-day mortality rate, procedural complications during TAVR, and a composite of death from any cause and heart failure requiring rehospitalization at 1 year. Results: At 1-year follow-up, the EOA in the larger valve groups was greater than that in the recommended valve group in each zone (Zone 1: 1.45 ± 0.03 vs. 1.06 ± 0.06 cm2, p < 0.001; Zone 2: 1.83 ± 0.05 vs. 1.41 ± 0.05 cm2, p < 0.001; Zone 3: 1.93 ± 0.07 vs. 1.69 ± 0.07 cm2, p = 0.02). No significant difference in the secondary endpoint was observed in any of the zones. Conclusions: Implantation of the out-of-range larger SAPIEN 3 THVs with underfilling was associated with greater EOA at the 1-year follow-up and feasible in the selected patients.

Original languageEnglish
Pages (from-to)2082-2091
Number of pages10
JournalCatheterization and Cardiovascular Interventions
Issue number7
Publication statusPublished - Jun 1 2022


  • AVD—aortic valve disease
  • electron beam CT/multidetector CT
  • ICT—imaging
  • ITTE—imaging
  • SHDI—structural heart disease intervention
  • TVI—transcatheter valve implantation

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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